Provider Demographics
NPI:1669687844
Name:GREER NEUROSURGERY CLINIC
Entity Type:Organization
Organization Name:GREER NEUROSURGERY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT/CLAIMS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-323-9433
Mailing Address - Street 1:PO BOX 3123
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-3123
Mailing Address - Country:US
Mailing Address - Phone:318-323-9433
Mailing Address - Fax:318-361-2680
Practice Address - Street 1:414 WOOD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7445
Practice Address - Country:US
Practice Address - Phone:318-323-9433
Practice Address - Fax:318-361-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.010638174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1793795Medicaid
LA1793795Medicaid